[Acute myocardial infarction overlooked during preoperative evaluation: usefulness of measuring highly sensitive troponin I].

A 68-year-old man was admitted to our hospital with an open fracture. Physical examinations of the patient showed normal status, and laboratory examination and chest X-ray film showed no abnormal findings. Electrocardiogram revealed ST-segment elevations in V2 and V3, but diagnosed as an early repolarization by a cardiologist. We noticed when he entered the OR that highly sensitive troponin I (hsTnI) level was 0.303 ng ml-1 (cut off : 0.04ng ml-1). Since he had no symptoms suggesting acute coronary syndrome, we proceeded with the operation partly supported by the golden time for the operation. Except Spo2 92% on arrival at the OR, the anesthetic course was uneventful. Soon after extubation, Spo2 dropped below 90% and he was re-intubated. After a thorough evaluation, he was diagnosed with acute myocardial infarction (AMI) and underwent emergency percutaneous coronary intervention. In this case, hsTnI value was slightly elevated before the surgery. Since there is increasing evidence that hsTnI is a sensitive and specific marker for early diagnosis of AMI, we have to take the value into consideration.